What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Schizophrenia (n=37467). Intervention: Second-generation antipsychotics (SGAs) vs. Baseline (start of treatment). Primary outcome: Mean change in body weight from baseline for olanzapine (Mean change 4.52 kg, 95% CI 3.62, 5.42).

March 9, 2021Open Access

Second-Generation Antipsychotic Drugs for Patients with Schizophrenia: Systematic Literature Review and Meta-analysis of Metabolic and Cardiovascular Side Effects

Key Result

Olanzapine and risperidone reported the greatest weight gain (4.52 kg and 4.19 kg), while lurasidone showed the lowest increase in body weight (0.43 kg) and a reduction in BMI.

Study Design

Type

Meta-Analysis (n=37,467)

Multicenter

Yes

Structured PICO

Do different second-generation antipsychotics have varying impacts on metabolic and cardiovascular side effects in adult patients with schizophrenia?

Population

37,467 adult patients (aged ≥ 18 years) with schizophrenia pooled from 79 studies (61% RCTs, 39% observational studies), mean age 36 ± 7.3 years, 62% male.

Intervention

Second-generation antipsychotics (SGAs) as a class, specifically oral lurasidone, aripiprazole, olanzapine, paliperidone extended release (XR), quetiapine XR, and risperidone.

Comparator

Baseline values (assessing mean variation of metabolic parameters between the start of treatment and the end of follow-up for each SGA).

Outcome

Mean variation between the start of treatment and the end of follow-up for metabolic and cardiovascular parameters: body weight, body mass index (BMI), total and high-density lipoprotein (HDL) cholesterol, triglycerides, fasting glucose, systolic and diastolic blood pressure.safety

Different second-generation antipsychotics exhibit distinct metabolic and cardiovascular safety profiles, with lurasidone showing a more favorable metabolic profile compared to olanzapine, risperidone, and quetiapine XR.

Main Result

Effect estimate: Mean change 4.52 kg (95% CI 3.62, 5.42)

Limitations

Differences in the mean dosages per patient across studies
Impact of different side effects on patients' quality of life was not considered
Management of other adverse events was not considered

Abstract

BACKGROUND AND OBJECTIVES: Second-generation antipsychotics (SGAs) for schizophrenia show different risk profiles, whose evidence has been evaluated through comparative reviews on randomized controlled trials (RCTs) and observational studies. METHODS: metric) was used. RESULTS: Seventy-nine papers were selected from 3076 studies (61% RCTs, 39% observational studies). Olanzapine and risperidone reported the greatest weight gain and olanzapine the largest BMI increase. Paliperidone showed the highest increase in total cholesterol, but is the only drug reporting an increase in the HDL cholesterol. Quetiapine XR showed the highest decrease in fasting glucose. Lurasidone showed the lowest increase in body weight and a reduction in BMI and was also the only treatment reporting a decrease in total cholesterol and triglycerides. The highest increase in systolic and diastolic blood pressure was reported by quetiapine XR. CONCLUSIONS: Despite some limitations (differences in the mean dosages per patient and other side effects not included) this paper provides the first complete meta-analysis on SGAs in variations on metabolic risk profile between start of treatment and end of follow-up, with useful results for clinical practice and possibly for future economic evaluation studies.

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